Malaria

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Prevention of reintroduction

At present, five countries are classified by WHO as being in the prevention of reintroduction phase following the recent cessation of local malaria transmission (Egypt, Georgia, Iraq, Oman, the Syrian Arab Republic).

Once malaria transmission is reduced to zero in an area, the objective of the ensuing phase is to prevent re-establishment of local malaria transmission. Importation of malaria by international travellers carries the risk of eventual resumption of local transmission in areas where the vector is still present and conditions for onward transmission are favourable. The success of this phase depends heavily on the strength of general healthcare services, the country’s overall strategy for communicable disease control, and collaboration with other sectors, including agriculture, industry, environment, foreign affairs and tourism.

Malaria-free status may have two important consequences: i) an increasing reluctance to commit personnel, time and expenditure to a disease that does not occur anymore, and ii) a loss of skills, due to the absence of cases, for the clinical and microscopic diagnosis of malaria and for the epidemiological investigation of cases. To sustain vigilance for continued efforts against malaria, a high-level technical nucleus of personnel must be retained in the country, as well as systems for prompt diagnostic testing of suspected cases and treatment of confirmed cases.

Ongoing capacity-building and training is required to raise awareness of factors that may increase an area’s vulnerability and receptivity to re-emergence of the disease, to refresh medical professionals’ skills on the diagnosis, treatment and prevention of malaria, and to maintain diagnostic capacities in laboratories.